Topeka ? A budget-balancing proposal from Republican Gov. Sam Brownback would deny needed medications to the poor and mentally ill in Kansas, health care advocates told legislators Wednesday.

Brownback’s measure is aimed at cutting prescription drug costs for the state’s Medicaid program, which provides health coverage to 362,000 poor and disabled Kansas residents. The proposal would allow the program to use “step therapy” in prescribing drugs, requiring patients to try less expensive medications and have the treatment fail before obtaining more expensive drugs.

The Senate Public Health and Welfare Committee took testimony on a bill that would repeal a state law banning step therapies in Medicaid. Brownback’s administration projects the change would save the state $10.6 million during the fiscal year beginning July 1 and it is part of a larger plan to close a projected $190 million budget deficit.

Critics questioned Wednesday whether the state will actually see any savings, predicting that some people with chronic conditions such as diabetes or multiple sclerosis will have trouble controlling them and suffer expensive complications. Advocates said people suffering from severe mental illnesses can end up homeless or in jail if their medications don’t work.

“This isn’t only inhumane. It’s inefficient,” said Susan Crain Lewis, president and CEO of the Kansas City, Kansas-based advocacy group Mental Health America of the Heartland.

The committee took no action on the bill.

Sen. Jim Denning, an Overland Park Republican, testified for the bill, noting that step therapy is common in private health insurance plans. And three private health insurance companies manage Medicaid for Kansas.

Denning said Medicaid has an incentive to make sure participants receive proper medications to avoid costly medical complications. He also said the intent isn’t to limit the use of drugs that treat severe mental illnesses and he’s open to language to make that clear.

Both Denning and Aaron Dunkel, deputy secretary for the state Department of Health and Environment, said Medicaid also wouldn’t require participants to give up drugs they’re now receiving for less expensive ones.

But Dunkel said step therapy is “a process that makes sense” in many cases.

Brownback told reporters after the meeting that the companies managing Medicaid for Kansas track the medical outcomes for patients and haven’t raised the same concerns as health advocates.

But he said, “We’ll review everything we can.”

Health care advocates said supporters of the bill are underestimating the difficulties that step therapy programs impose on patients and doctors.

Dr. Eric Voth, chief of primary care at the Topeka-based Stormont Vail Health system, said obtaining authorizations for new prescriptions under step-therapy programs for private health plans typically requires between 20 minutes and an hour of work. He said it becomes a “game of cat and mouse” with insurers.

“You have medical decision and medical judgment taken away from practitioners,” he said.

Gayle Taylor-Ford, an Overland Park social worker whose 49-year-old husband has both diabetes and multiple sclerosis, said his private health plan requires step therapy. Her husband can’t walk upright while he awaits the correct medications, she said.

“This prior-authorization process is still going on nearly two months later,” she said. “We still don’t have the medication we need.”